Intraoperative details of silicone frontalis suspension
Richard C. Allen, MD, PhD
Additional Notes: Length 02:20
Posted March 20, 2017
This is Richard Allen at the University of Iowa. This video demonstrates the surgical details in placement of a silicone frontalis sling. The patient has had a small blepharoplasty marked on each side. Dissection is then carried out through the skin and orbicularis and the orbital septum is identified and opened. The preaponeurotic fat is dissected from the underlying levator aponeurosis. The levator aponeurosis is then dissected from the anterior surface of the tarsus with a thermal cautery. Thermal cautery is then used to dissect between the levator aponeurosis and the underlying Mueller's muscle. A 5-0 Mersilene suture is then placed partial thickness through the anterior surface of the tarsus 2 millimeters inferior to the superior border of the tarsus. The sling is fixated to the anterior surface of the tarsus with the Mersilene sutures. Approximately 3 sutures are needed. The sling is then placed in a retroseptal fashion to exit out the incisions above the brow. The eyelid incisions will then be closed with interrupted 5-0 fast absorbing sutures. The sutures engage the eyelid skin followed by the cut end of the levator aponeurosis, followed by the eyelid skin. This is performed along the length of the eyelid. Usually, approximately 5 sutures are needed in order to create a good lid crease. I think the surgical principles of frontalis suspension include tarsal fixation, conservative skin excision, no preaponeurotic fat excision, retroseptal placement of the frontalis sling, and incorporation of the cut end of the levator aponeurosis into the eyelid closure. This will result in a good lid crease in these patients.
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